Higher costs for PPACA’s bronze plans

By BenefitsPro

By Kathryn Mayer

Consumers who think they might be scoring a cheap health plan under PPACA might be in for a rude awakening, as new analysis shows those who chose the cheapest health plans will be hit with higher out-of-pocket costs.

New analysis of early health insurance rate filings from HealthPocket finds that PPACA’s bronze plans— the least expensive plans under the law — have higher out-of-pocket costs for consumers compared to plans in the individual and family insurance market right now.

While most states have yet to publish their rates, “bronze plan“ filings from California, Connecticut, Ohio, Oregon, Rhode Island, Vermont, and Washington indicate that for these entry-level plans, consumers could pay more in deductibles, copayments and coinsurance for their medical services than they do now, researchers said.

Based on a review of more than 9,500 health plans in the individual and family health insurance market, copayments for doctor visits were estimated at $28 on average. By comparison, bronze plans averaged a $41 copayment — an increase of 46 percent.

The lowest bronze plan copayment for a doctor was $15 and the highest was $60. For doctor visits where a coinsurance fee is charged instead of a flat fee copayment, the national average is 24 percent. Bronze plans that charge coinsurance averaged 27 percent, an increase of 13 percent.

HealthPocket researchers also cautioned there will be significant increases in average plan deductibles as changes are coming to how deductibles work for doctor visits.

In the pre-reform market, 37 percent of health plans include doctor visits as part of the deductible. For the new bronze plan filings, 84 percent had doctor visits subject to the deductible. For bronze plan consumers this means they’re likely to be charged the full amount for some doctor visits until they have met their plans’ deductible.

“We know that consumers’ number one concern about health insurance is what they will have to pay for it,” said Kev Coleman, head of research and data at HealthPocket. “People shopping for insurance need to worry about two things: the cost of their monthly premium and what out-of-pocket costs they face. By considering both factors together rather than in isolation from one another, consumers can make the best financial decision for their health care.”

Bronze plans are expected to be the most popular plan among cost-conscious consumers as it’s the least expensive level health plan.

A previous survey from HealthPocket in April found that most consumers don’t understand the most fundamental change to health plan designs under health reform. When respondents were asked how the new PPACA bronze, silver, gold and platinum health plans differ from one another, 86 percent said they didn’t know.

Data on cost-sharing for available health plans was collected on June 11, 2013, from 9,727 health plans within the individual and family health insurance market.

The PPACA creates four basic health plan designs — bronze, silver, gold and platinum — to replace existing health plans and address the needs of most plan shoppers who aren’t enrolled in a grandfathered health plan, Medicaid or Medicare.